Category: Health and Health Care
Background: Family history of cardiovascular disease (FHxCVD) is a CVD risk indicator that captures the influence of genetic and shared familial factors and is readily available to individuals and clinicians. Though CVD risk factors associate with greater risk of cognitive impairment, less is known about the association between FHxCVD and self-reported cognitive function. Evaluating this association may further elucidate links between cardiovascular and cognitive health.
Methods: The Emory Healthy Aging Study isa community-based prospective cohort study aimed at identifying predictors of healthy aging and age-related diseases. Participants are primarily residents of the Atlanta area, at least 18 years old, who completed an online baseline health survey. Information about demographic (age, self-reported race, gender), socioeconomic (education, household income), lifestyle (physical activity, smoking) and CVD risk factors (diabetes, hyperlipidemia, BMI, hypertension) and family health history were collected at enrollment. Family history of CVD was defined as self-reported history of coronary artery disease, myocardial infarction, or stroke for any biological parent or sibling. Self-reported cognitive function was measured using the validated Cognitive Function Instrument (CFI) and categorized into quartiles. Associations between FHxCVD and CFI score quartile were assessed using multinomial logistic regression, adjusting for demographic, socioeconomic, lifestyle and the participant’s own CVD risk factors, as well as family history of any diagnosed cognitive impairment.
Results: We studied 6,115 participants (75% female, 84% white, 11% black, and 5% other self-reported race), without existing CVD, recruited between October 2015 and 2017. Mean age was 59±13 years and 61% reported a family history of CVD. Comparing extreme quartiles of CFI score, adjusted for demographic, socioeconomic, and lifestyle factors, plus family history of any diagnosed cognitive impairment, FHxCVD was associated with poorer self-reported cognitive function (OR=1.43; 95% CI (1.21, 1.70)). The OR after additional adjustment for CVD risk factors was not meaningfully different (OR=1.47; 95% CI (1.23, 1.76)). In the same fully adjusted model, the estimated OR for family history of any cognitive impairment was slightly larger: 1.54 (1.30, 1.83).
Conclusion: In this cross-sectional community sample, family history of CVD was associated with poorer self-reported cognitive function, and this association was of a similar magnitude as having a family history of cognitive impairment. Although longitudinal studies are needed, these results underscore the link between cardiovascular and cognitive health. Twin studies are needed to estimate the contribution of genetic and shared familial factors.
Margarethe Goetz– Postdoctoral Fellow, Emory University, Decatur, Georgia
Michele Marcus– Professor of Epidemiology, Environmental Health and Pediatrics, Emory University
Liping Zhao– Senior Biostatistician, Emory University
Viola Vaccarino– Professor, Chair of Epidemiology, Emory University
Felicia Goldstein– Professor of Neurology, Emory University
Allan Levey– Professor and Chair of Neurology, Emory University
James Lah– Associate Professor of Neurology, Emory University
Dr. Margarethe Goetz earned her PhD in Epidemiology, with a focus on nutritional and cardiovascular epidemiology, from the Rollins School of Public Health at Emory University in 2016. Prior to her doctoral training she worked as a Physician Assistant in Neurocritical Care at Rhode Island Hospital and UMass Memorial Medical Center. She joined the Emory Healthy Aging Study in 2016.
Professor of Epidemiology, Environmental Health and Pediatrics
She has over 20 years experience conducting large epidemiologic cohort studies. Dr. Marcus received her MPH and PhD in Epidemiology at Columbia University as well as completing a fellowship in Neuroepidemiology. As Assistant Director of the Center for Health Research for Kaiser Permanente Georgia, she established a biobank with 85% participation of African American and Caucasian women and served on the Leadership Team for Kaiser’s National Biobanking efforts. She has been invited to speak at national and regional IRB organization meetings concerning ethical issues of biobanking and studying genetic information. She has received continuous federal funding for nearly 20 years as PI of a long-term follow-up study of individuals exposed to toxicant-contaminated food. This cohort study now contains multiple generations and strong community involvement. She has published extensively on multi-generational health effects utilizing several cohorts including the Avon Longitudinal Study of Parents and Children. Dr. Marcus has conducted several federally-funded studies evaluating psychosocial stress and ergonomic stress as predictors of adverse musculoskeletal health outcomes and a randomized clinical trial of an ergonomic intervention. She has contributed to the scientific literature in multiple areas of cohort research from recruitment and community engagement to data collection and analyses.
Dr. Marcus has served on federal expert panels reviewing health effects of electromagnetic fields, bisphenol A, phthalates, gene/environment interactions and service in the Persian Gulf War. She served on the National Academy of Sciences Institute of Medicine Committee on dioxin exposure among Vietnam Veterans. She has studied the health consequences of various exposures including psychosocial stress, PCBs, PBBs, PFCs and electromagnetic fields.
Dr. Marcus has served in many additional leadership positions including Director of Graduate Studies and Interim Chair for the Department of Epidemiology and Co-Director of the Southeast Pediatric Environmental Health Specialty Unit. Her research on multi-generational health effects has been recognized with awards from the CDC and the EPA. She currently serves on the Leadership Team for the Emory Healthy Aging Study.
Professor, Chair of Epidemiology
Dr. Vaccarino is Professor and Wilton Looney Chair of Cardiovascular Research, Department of Epidemiology, Rollins School of Public Health, Emory University, with a joint appointment in the Department of Medicine, Division of Cardiology, Emory University School of Medicine. She received her MD degree from the University of Milan, Italy, in 1984, and her PhD degree in epidemiology from Yale University in 1994. In 1995 she was appointed assistant professor at the Yale University School of Medicine. In 2000 she left Yale to join the faculty of the Emory University School of Medicine where she reached the rank of Professor of Medicine in 2006. In March 2010 Dr. Vaccarino was appointed the Rollins Professor and Chair of the Department of Epidemiology at the Rollins School of Public Health. Since 2005, Dr. Vaccarino has directed the Emory Program in Cardiovascular Outcomes Research and Epidemiology ("EPICORE"), a multidisciplinary research group concentrating on clinical and population epidemiology, outcomes research, clinical trials and translational research in cardiovascular diseases and related disciplines. Between 2005 and 2008 she was also the medical director of the Emory Heart Center Information Services, which supports as an investigative resource the Emory Cardiac Database, one of the nation’s original and largest computerized cardiovascular databases.
Professor of Neurology
Felicia C. Goldstein is a Professor of Neurology (Neuropsychology Program) at Emory University School of Medicine. She received her PhD at Emory University and did postdoctoral fellowships at the Emory Center for Rehabilitation Medicine and the University of Texas Medical Branch in Galveston. Dr. Goldstein is Board Certified in neuropsychology by the American Board of Professional Psychology/American Board of Clinical Neuropsychology, and is a Fellow of the American Psychological Association. Her clinical specialization is in geriatric neuropsychology, with a focus on the early detection of cognitive changes associated with mild cognitive impairment and Alzheimer’s disease. In 1989, Dr. Goldstein established a specialty neuropsychology clinic to provide support for the Department of Neurology Memory Disorders Program, and in 1991, she established a parallel clinic at Grady Memorial Hospital which serves a predominantly African American patient group. Through these active clinical services, she supervises and mentors undergraduate and graduate students in Clinical Neuropsychology.. Dr. Goldstein conducts clinical research on health disparities, the contribution of vascular comorbidities to disease features and progression in older adults, and the early detection of mild cognitive impairment and Alzheimer’s disease. She serves on the editorial boards of Ethnicity and Disease and Neurosurgery.
Professor and Chair of Neurology
Dr. Levey is the Goizueta Foundation Endowed Chair for Alzheimer’s Disease Research, Betty Gage Holland Chair, and Professor and Chairman of the Department of Neurology at Emory University. He is also Associate Dean for Research at Emory University School of Medicine and Director of the Emory Alzheimer’s Disease Research Center.
Dr. Levey received a BS from the University of Michigan and an MD and PhD (Immunology) from the University of Chicago. He then trained in Neurology at Johns Hopkins, molecular biology at the National Institutes of Health, and then joined the Johns Hopkins faculty in the Departments of Neurology and Pathology. Dr. Levey has been at Emory University since 1991, where he has held a number of positions, including Director of Graduate Studies for the Neuroscience PhD Program, Founding Director of the Emory Center for Neurodegenerative Disease, and Director of the Emory MD/PhD Training Program.
Dr. Levey is a neurologist and neuroscientist internationally recognized for his work in neurodegenerative disease. He has more than 300 research publications. His work has contributed to understanding the brain systems and mechanisms involved in neurodegenerative disorders including Alzheimer’s and Parkinson’s diseases, and in identifying molecular targets for new therapeutic strategies. He has received several awards including the Derek Denny Brown Neurological Scholar Award from the American Neurological Association, the Heikkila Research Scholar Award from the National Parkinson Foundation, the Health Advancement Research Award from Community Health Charities, the Team Hope Award for Medical Leadership from the Huntington’s Disease Society of America, and he was inducted into the Johns Hopkins Society of Scholars. Dr. Levey was also named an ISI Highly Cited Researcher in the field of Neuroscience and has consistently been listed as one of the Best Doctors in America.
Associate Professor of Neurology
Dr. James Lah graduated with honors from Duke University in 1984, and subsequently enrolled as a Medical Scientist Program Fellow at Ohio State University, where he earned his MD/PhD in 1992. After an internship in Medicine, Dr. Lah completed his Neurology Residency at Emory from 1992 to 1996. At the end of his clinical training, he was awarded a Clinical Investigator Development Award from the National Institutes of Health and joined the Emory Neurology faculty.
During his career, Dr. Lah has led basic laboratory research efforts, as well as the development of a multidisciplinary team devoted to the care of patients with Alzheimer’s and other degenerative brain diseases. He is currently the Associate Professor and Vice Chair of Neurology at Emory University, where he also serves as Director of Emory’s Cognitive Neurology Program and Clinical Core Leader of the NIH funded Alzheimer’s Disease Research Center. In addition, he serves as a member of several key committees for the Emory School of Medicine, the National Institutes of Health, and the American Federation for Aging Research. Dr. Lah has received national and international recognition for his leadership in Alzheimer’s research, and in 2009, Emory University appointed Dr. Lah to the Alice and Roy Richards Endowed Chair for Alzheimer’s Disease.